Cannabis Legalization's Effects on Youth and Adult Nicotine and Tobacco Use

项目总结 在过去的20年里，美国的合法大麻格局发生了重大变化，同时标志着 烟草使用的变化是可预防死亡的主要原因。然而娱乐性大麻合法化 (RCL)对烟草产品使用的影响仍不清楚：很少有同行评议的研究直接测试这些影响 和准实验分析--在没有随机化的情况下产生因果估计的方法 在大麻是经济上的补充还是香烟的替代品方面，得出了不同的结论。这些 动态是至关重要的：增加大麻获取的法律将减少其替代品的使用，并增加大麻的使用 它与之相辅相成。此外，准实验研究在很大程度上忽略了RCL对非香烟使用的影响 烟草产品，如雪茄和电子尼古丁输送系统(END)，以及 国家大麻政策细节(如税率、配方限制)和地方大麻法律(如地方税收、 送货上门禁令)。如果没有预料到这种影响，政策制定者对RCL成本和 福利将是不正确的，州和地方政策制定者都可能错过构建大麻结构的机会 以更好地保护其社区健康的方式制定法律。为了解决这个问题，我们将汇编一份大麻 涵盖州RCL政策详细信息、当地大麻政策和零售商密度的政策数据库，并将其与 来自全国药物使用与健康调查的具有全国代表性的限制使用数据。目标1A将 使用这些数据来描述当地获得大麻零售商、当地大麻政策和国家的差异 RCL政策细节可能会影响RCL州内大麻的获取和使用。目标1B将评估这些政策 与大麻零售商密度、感知的大麻获取便利性和大麻使用的关系，阐明了它们的 作为当地大麻零售商密度和易获得性的明确代理人的优势，并澄清 这些政策对大麻使用的影响足以使对大麻使用的工具变量分析成为可能 对烟草制品使用的影响。考虑到香烟、雪茄、烟头和钝器，目标2将估计RCL的直接 对成人烟草产品使用的影响，测试来自国家RCL政策细节和地方的效果修改 大麻定律，并模拟替代RCL场景下烟草产品使用的影响(例如， 联邦RCL、不同的大麻税率、先发制人地禁止零售)。AIM 3将并行进行 针对12-20岁青少年的分析和模拟。结果将扩展关于RCL对烟草影响的文献 通过占一系列烟草产品的产品使用，并通过考虑效果来增加其严格性 由于国家政策细节和当地大麻法律的变化而进行的修改，分别针对未成年人和 21岁以上年龄组。此外，对替代政策对烟草和尼古丁使用的影响的模拟将澄清 不同的州和地方大麻政策的潜在意外成本或好处，帮助政策制定者 确定政策选择，以最好地确保在消除烟草在其社区造成的损失方面继续取得进展。

PROJECT SUMMARY The past 20 years have seen significant changes in the US’s legal cannabis landscape alongside marked changes in tobacco use, the leading cause of preventable mortality. Yet recreational cannabis legalization’s (RCL’s) effects on tobacco product use remain unclear: few peer-reviewed studies directly test these effects and quasi-experimental analyses—methods to generate causal estimates in the absence of randomization— yield mixed findings on whether cannabis is an economic complement or substitute for cigarettes. These dynamics are crucial: laws increasing cannabis access will decrease use of its substitutes and increase use of its complements. Moreover, quasi-experimental studies largely ignore RCL’s effects on use of non-cigarette tobacco products like cigars and electronic nicotine delivery systems (ENDS), as well as potential effects of state cannabis policy details (e.g., tax rates, formulation restrictions) and local cannabis laws (e.g., local taxes, home delivery bans). If such effects are not anticipated, policymakers’ expectations of RCL’s costs and benefits will be incorrect, and both state and local policymakers may miss opportunities to structure cannabis laws in a manner that better protects their community’s health. To address this, we will compile a cannabis policy database covering state RCL policy details, local cannabis policies, and retailer density, and match it to nationally representative, restricted-use data from the National Survey on Drug Use and Health. Aim 1A will use these data to characterize variation in local access to cannabis retailers, local cannabis policies, and state RCL policy details likely to impact cannabis access and use within RCL states. Aim 1B will assess these policies’ relationships to cannabis retailer density, perceived ease of cannabis access, and cannabis use, elucidating their strength as unconfounded proxies for local cannabis retailer density and ease of access, and clarifying whether the policies’ effects on cannabis use are strong enough to allow instrumental variable analyses of cannabis use’s effect on tobacco product use. Considering cigarettes, cigars, ENDS, and blunts, Aim 2 will estimate RCL’s direct effects on adult tobacco product use, test for effect modification from state RCL policy details and local cannabis laws, and simulate implications for tobacco product use under alternative RCL scenarios (e.g., federal RCL, different cannabis tax rates, preempting local bans on retail sales). Aim 3 will conduct parallel analyses and simulations for 12-20 year-olds. Results will extend the literature on RCL’s effects on tobacco product use by accounting for a range of tobacco products, and increase its rigor by considering effect modification due to variation in state policy details and local cannabis laws, separately for underage versus 21+ age-groups. Moreover, simulations of alternative policies’ effects on tobacco and nicotine use will clarify potential unanticipated costs or benefits of different state and local cannabis policies, helping policymakers identify policy options to best ensure continued progress towards eliminating tobacco’s toll in their community.